摘要
目的比较靶控输注(TCI)瑞芬太尼和单次静脉注射右美托咪定(Dex)在全凭静脉麻醉(TIVA)下经蝶骨垂体瘤切除术苏醒期中抑制呛咳的不同效果。方法收集TIVA下行经蝶骨垂体瘤切除手术患者60例,随机分2组,即瑞芬太尼TCI组(R组)和Dex组(D组)。手术结束前10 min,R组瑞芬太尼血浆靶浓度设为2.0ng/mL至拔管;D组停止瑞芬太尼TCI,同时取Dex 0.5μg/kg稀释至10mL,于10min内泵注结束。观察2组拔管期间发生呛咳的情况以及是否出现不良反应;记录患者的基础、拔管即刻、拔管后5 min和出恢复室的心率(HR)、平均动脉压(MAP)和呼吸频率(RR);记录手术、自主呼吸恢复、睁眼和拔管时间。结果苏醒期R组发生呛咳的例数显著少于D组,睁眼及拔管时间显著快于D组。出恢复室时,R组的MAP及HR显著高于D组;拔管时,R组的RR慢于D组,但5min后,2组的RR差别无统计学意义。结论丙泊酚TIVA下经蝶骨垂体瘤切除术中,在抑制苏醒期呛咳方面,瑞芬太尼TCI优于单次静脉注射Dex,同时可实现平稳快速苏醒,但单次静脉注射Dex在维持血流动力学方面更具有优势,且无明显抑制呼吸的作用。
Objective To compare the effects of remifentanil target-controlled infusion（TCI） with a single-dose of dexmedetomidine for preventing eough during recovery period from total infusion venous anesthesia（TIVA） in patients undergoing transsphenoidal hypophysectomy. Methods Sixty patients un- dergoing transsphenoidal hypophysectomy under TIVA were randomly assigned to two groups. Remifen- tanil TCI （Group R） and dexmedetomidine（Group D）. Ten minutes before the end of the surgery, remifentanil TCI at a concentration of 2.0 ng/mL was set and maintained during the recovery period until extubation in group R. In group D, remifentanil was discontinued, and 10 mL of dexmedetomidine 0.5 mg/kg mixed with normal saline was given in ten minutes. The cough grade and adverse reactions- were evaluated during the periextubation period. Heart rate（HR）, mean arterial pressure（MAP）, and respiratory rate（RR） were recorded at the following time points： before anesthesia, extubation, 5 min after extubation and before leaving post anesthesia care unit（PACU）. The duration of surgery and time to spontaneous respiration, open eyes and extubation were recorded. Results The proportion of patients without coughduring extubation was significantly lower in group R than in group D （P〈0.05）, and the time to open eyes and extubation were shorter in group R（P〈0.05）. The changes of MAP and HR were not signifi- cantly different during extubation between the two groups, but higher in group R when patients left PACU （P〈0.05）. RR was lower in group R（P〈0.05） when extubation,but there was no difference 5 minutes after extubation. Oonclusion During the recovery period from TIVA in patients undergoing transsphe- noidal surgery, remifentanil TCI can prevent cough more effectively than a single-dose of dexmedetomi- dine, targeting rapid and smooth recovery. However, a single-dose of dexmedetomidine has the effect on hemodynamic stability and respiratory during the recovery.
出处
《福建医科大学学报》
北大核心
2016年第5期320-324,共5页
Journal of Fujian Medical University
关键词
哌啶类
输注
静脉内
安定镇痛
垂体肿瘤/＊外科学
咳嗽
piperidines
infusions, intravenous
neuroleptanalgesia
pituitary neoplasms
surgery
cough
